The Role of Bone Grafting in Corrective Osteotomy of Distal Radius Malunions

Ryan Paul; Jonathan Persitz; Shawn Khan; Michael MacDougall; Andrea Chan

doi:10.1055/s-0044-1787539

Journal of Wrist Surgery, Table of Contents

J Wrist Surg 2025; 14(02): 184-193
DOI: 10.1055/s-0044-1787539

Survey or Meta-Analysis

The Role of Bone Grafting in Corrective Osteotomy of Distal Radius Malunions

Authors

Ryan Paul^*

¹Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

²Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Jonathan Persitz ^*

¹Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

²Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Shawn Khan

²Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Michael MacDougall

²Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Andrea Chan

¹Hand Program, Division of Plastic, Reconstructive and Aesthetic Surgery, University Health Network, Toronto Western Hospital, affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

²Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

Abstract

Background It remains unclear whether bone grafting is required during corrective osteotomy of the distal radius. The goal of this systematic review is to determine the union, revision, and complication rates of bone grafting techniques associated with extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating.

Questions Is bone grafting in distal radius corrective osteotomy associated with increased rates of bone union and reduced rates of revision surgery and complications?

Materials and Methods A comprehensive search of the MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases was completed for studies reporting clinical outcomes of extra-articular corrective osteotomy for dorsally malunited distal radius fractures treated with volar plating.

Results A total of 13 studies, with 14 intervention arms and 236 patients, were included. Bone grafting techniques consisted of autograft (6 studies, n = 93), synthetic bone grafts (2 studies, n = 38), allograft (1 study, n = 14), or no grafting (5 studies, n = 91). The overall union rate was 97%, and the mean time-to-union was 12.0 weeks. Larger corrections of dorsal tilt and ulnar variance were performed in the autograft and allograft groups. Complication and revision rates were highest in the synthetic group, 45 and 26.3% respectively.

Conclusion Grafting in extra-articular corrective osteotomy for dorsally angulated distal radius malunions treated with volar plating is not associated with an improved union rate in the literature. However, larger corrections were achieved in both the autograft and allograft groups compared to the no-graft and synthetic groups, resulting in similar union rates. Synthetic bone grafting was associated with the highest complication and revision rates. Future comparative prospective trials and proper documentation of whether cortical contact was present or absent are required to assess whether bone grafting warrants consideration in more advanced deformities.

Level of Evidence IV.

Keywords

radius - malunion - osteotomy - graft - union

Full Text

References

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